New Client Form - Dog Training Class 2023

venturapetwellness.com shannonvpw@gmail.com (805) 620-7616

Ventura Pet Wellness & Dog Training Center

New Client Information Form - Dog Training Classes

Please fill this form out if this is the FIRST TIME your dog has attended a group class at Ventura Pet Wellness & Dog Training Center. Please DO NOT fill out this form for a Private Training Session with Shannon Riley (Coyner

We encourage you to check out "The Evolution of Dog Training" by Shannon Riley (Coyner) available as eBook, Print book or Audiobook on AMAZON!

All class paperwork found on our paperwork page of the website must be returned via email or by mail, prior to the class start date; even if it is a repeat class that you have taken multiple times. (Please contact us for mailing address)

A first-time student is for dogs that HAVE NEVER attended a class at Ventura Pet Wellness. Please enroll into the class below by clicking "sign up" on the class schedule page. Once you have enrolled into theclass, please fill out the required paperwork specified below under "first time student". Payment must be received in order for your spot to be held. First time students sign up checklist:

1.Submit class payment upon sign up by PayPal or you may pay by check payable to Ventura Pet Wellness and return by mail (please contact US for mailing address 2. New Client Form Dog Training Classes 3. Registration Form 4. Ventura Pet Wellness & Dog Training Center Policy Form 5. Copy of your dog's most recent vaccinations

Name

Today's Date

Date

Second Owner Cell/ Alternative Phone

Address

City

State

Zip

Home Phone

Work Phone

Cell Phone

Fax

E Mail

Who can we thank for your referral?

Name

Breed

Age

Weight

Sex

Color

Dog Class

Class Dates

Date

Veterinarian

Phone

Spayed/ Neutered

If yes, at what age?

Reason

Any behavioral changes following spay/neuter?

Where did you get your dog?

Does your dog show any of these signs?

If yes please give a brief description

Has your dog shown aggression to new and/or familiar people? If yes please describe

Is your dog reactive to other dogs? If yes please describe

Has your dog ever bitten a person or other dog (please specify which one)? If yes please describe the situation and the seriousness of the bite:

If yes please describe the situation and the seriousness of the bite

Does your dog continuously bark in the presence of another dog? If yes do you think your dog will bark for most of the class?

Please read and check off each box before you sign.

I hereby acknowledge that have voluntarily applied to participate in dog training activities with Shannon Riley (Coyner), RVT, CPDT-KA KPA CTP and Ventura Pet Wellness & Dog Training Center. I am aware that there are inherent risks and hazards involved in activities with and around dogs, and I am voluntarily participating in these activities with knowledge of potential dangers. I am aware that any dog, regardless of training, handling, or environmental circumstance, is capable of biting and I expressly acknowledge the risks therein. In order to participate in dog training classes or other activities, I, being fully informed of such risks and hazards, agree to assume all risks of such occurrences. I hereby waive any and all claims or actions that or my guardians or representatives may have, from any and all personal injury to myself, my dog, children in my charge, or harm to property or person caused directly or indirectly, through action or inaction of self or others, by acts that might occur in dog training classes, any other format of training activities or secondary training without trainer present or engaged.

I hereby acknowledge that the use of a pinch, prong collar, electric collar or anything that will cause harm to your dog will not be allowed when training with Shannon Riley (Coyner) and Ventura Pet Wellness & Dog Training Center. If a pinch or prong collar is used, your appointment(s) will be cancelled without a refund.

A dog trainer shall deliver to a purchaser of dog training services at the time of purchase of the dog training services, a written disclosure containing all of the following:(1)The trainer's name and address.(2)Any civil judgments related to the dog trainer's services, or a statement that no judgments exist.(3)Any criminal animal cruelty convictions against the dog trainer or an employee of a dog trainer that will be providing the dog training services to the purchaser, or a statement that no convictions exist.(b)The written disclosure made pursuant to this section shall be signed by the trainer certifying the accuracy of the statement, and by the purchaser of the training services acknowledging receipt of the statement.(c)A person may bring a civil action in a court of competent jurisdiction for damages arising from a violation of this section.Ca. Health and Saf. Code § 122395.2Added by Stats 2022 ch 276 (AB 1901),s 1, eff. 1/1/2023.

I agree to indemnify Shannon Riley (Coyner) and affiliates from any and al claims by myself, member of family, or any agent while within training facilities, within my home property, or in the general public as a result of any action or inaction, of either my dog or any another. I also agree to assume sole responsibility for injury or damage caused by myself, children in my charge, or by the dog I own or handle and further agree to indemnify, defend and hold the instructors, trainers, assistants and property harmless from any damage, loss, liability or expense, including legal cost and attorney's fees, which result from damage caused by myself, children in my charge, or by the dog I own or handle.

During the entire session dogs are not to socialize during class time as they are learning. All dogs must stay 6 ft or more apart from each other as some dogs like their space.

I have provided current vaccination documents from a licensed veterinarian. I understand that there are no refunds given 7 business days prior to the start date of class. I have read the policies for dog training and I agree to adhere to them.

Client Signature

Clear

Date

I grant to Ventura Pet Wellness its representatives and employees the right to take photographs of me and my dog in connection with training or classes I take with Ventura Pet Wellness. I authorize Ventura Pet Wellness its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Ventura Pet Wellness may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

Client Signature

Clear

Date